<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

 

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Custom_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-custom_id" data-rule="required" data-format-item="{name}【{phone}】" data-source="custom/index" class="form-control selectpage" name="row[custom_id]" type="text" value="">
        </div>
    </div>
   <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('物流方式')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-custom_id" data-rule="required" data-field="title" data-source="distribution/index" class="form-control selectpage" name="row[distribution_id]" type="text" value="">
        </div>
    </div>


 <div class="form-group" >
        <label class="control-label col-xs-12 col-sm-2">{:__('规格')}:</label>
        <div class="col-xs-12 col-sm-8">
            <table class="table table-responsive fieldlist" data-name="row[goods]" data-template="texttpl" id="options-form" data-tag="tr">
                <tr>
                    <td>商品</td>
                    <td >数量</td>
                    <td >价格</td>
                    <td></td>
                </tr>
                <tr>
                    <td colspan="5"><a href="javascript:;" class="btn btn-sm btn-success btn-append"><i
                                class="fa fa-plus"></i> 追加</a></td>
                </tr>
                <textarea name="row[goods]" class="form-control hide" cols="30" rows="5"></textarea>
            </table>
        </div>
        <script type="text/html" id="texttpl">
            <tr class="form-inline">

                <td><input type="text" name="row[<%=name%>][<%=index%>][id]" class="form-control selectpage" data-source="shop/goodsacct/index" data-field="goods.title" data-format-item="{goods.title}￥{price}" value="<%=row.id%>" style="width: 250px;"></td> 
               
                <td><input type="text" name="row[<%=name%>][<%=index%>][num]" class="form-control" step="0.01" value="<%=row['num']%>" size="5F"></td>
                <td><input type="text" name="row[<%=name%>][<%=index%>][pay_money]" class="form-control" step="0.01" value="<%=row['pay_money']%>" size="5F"></td>

                <td><span class="btn btn-sm btn-danger btn-remove"><i class="fa fa-times"></i></span></td>
            </tr>
            
        </script>
    </div>


   
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control" name="row[remark]" type="text" value="">
        </div>
    </div>
  

     <div class="form-group">
        <label for="c-id_card" class="control-label col-xs-12 col-sm-2">{:__('省市区')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
                <select class="province form-control" name="row[province]" data-url="ajax/cnarea" ></select>
                <select class="city form-control" name="row[city]" data-url="ajax/cnarea" ></select>
                <select class="area form-control" name="row[area]" data-url="ajax/cnarea"></select>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('详细地址')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-consign_address" class="form-control" name="row[consign_address]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-pay_image" class="form-control" size="50" name="row[pay_image]" type="text" value="">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-pay_image" class="btn btn-danger faupload" data-input-id="c-pay_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-pay_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-pay_image" class="btn btn-primary fachoose" data-input-id="c-pay_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-pay_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-pay_image"></ul>
        </div>
    </div>


    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
